Attitudes, Psychological Processes and Evaluation Methodologies of Electronic Cigarette Advertising: A Systematic Review.

Abstract

The aggressive proliferation of Electronic Nicotine Delivery Systems (ENDS) advertising represents a critical global public health concern, particularly due to its capacity to induce nicotine dependence in youth. This systematic review aimed to describe the specific attitudes and psychological processes (cognition and emotion) elicited by ENDS advertising, alongside identifying the current methodologies implemented for their evaluation. Primary empirical studies published between 2015 and July 2026 were systematically reviewed following PRISMA 2020 guidelines. The final corpus comprised twelve ([Formula: see text]) studies incorporating quantitative and mixed methods designs focused on young populations exposed to ENDS advertising. Searches were conducted across Scopus, ProQuest, ScienceDirect, EBSCOhost, and the Ministry of Health Digital Library, restricting eligibility to English and Spanish reports. Findings show that ENDS advertising employs visual, linguistic, and emotional persuasion strategies across the twelve included studies, demonstrating a dominance of quantitative approaches and an expansion toward randomized experimental designs (50.0%). Methodological quality appraisal reached an overall global compliance score of 93.9%. While earlier studies lacked explicit reporting on risk of bias, 33.3% of the corpus rigorously implemented method-level bias controls, including stimulus counterbalancing and objective biochemical verification via salivary cotinine. Messages evoking positive emotions (e.g., freedom, social belonging) and minimizing perceived risk foster favorable attitudes and consumption intentions by manipulating affective precursors while leaving cognitive harm calculations unchanged. Major gaps include an integration deficit between implicit and explicit attitudinal measures, as well as a historical shortage of longitudinal tracking. Despite these limitations, current evidence provides a robust empirical baseline for prevention practice, guiding the development of targeted public health counter-advertising campaigns and stricter structural regulations on product marketing features.